Local wound anesthesia in spine surgery – a randomized, double-blind, controlled trial

BACKGROUND: Effective postoperative pain control remains a major challenge in spine surgery. Local wound infiltration with anesthetics is a simple component of multimodal analgesia, yet high-quality comparative data between different infiltration regimens are limited. PURPOSE: To evaluate the analgesic efficacy and safety of ropivacaine and levobupivacaine/tramadol wound infiltration compared with placebo in lumbar spine surgery. STUDY DESIGN/SETTING: Prospective, randomized, double-blind, controlled clinical trial. PATIENT SAMPLE: 125 patients undergoing elective primary or revision lumbar spine surgery. OUTCOME MEASURES: Postoperative pain intensity (VAS 2-12 h), opioid consumption (24 h), length of hospital stay, sick leave, and adverse events. METHODS: Patients were randomized to receive intraoperative epifascial and subcutaneous wound infiltration with either 0.9% saline (placebo), 0.75% ropivacaine, or 0.5% levobupivacaine + tramadol (100 mg). Outcomes were analyzed using mixed-effects linear models and non-parametric tests. RESULTS: There were no significant differences in postoperative pain scores or opioid consumption between treatment groups at any time point. Hospital stay and functional recovery were comparable. Sick leave duration was shorter in the ropivacaine group compared with placebo (p = 0.021). No infiltration-related adverse events occurred. CONCLUSIONS: Local wound infiltration with ropivacaine or levobupivacaine/tramadol is safe but does not provide a clinically meaningful benefit in early postoperative pain control or opioid reduction after lumbar spine surgery. Broader multimodal strategies may be required to achieve optimal postoperative recovery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05693454.